Individual provider Active NPI

Eric Allen Azbell

  • Family Nurse Practitioner
  • New York, NY
National Provider Identifier
1659874709
Registry record updated Mar 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
351602 Issued in NY
Practice address
30 Broad St FL 45
New York, NY 10004-2942
Phone
(888) 663-6331
Fax
(415) 252-7176
NPI assigned
Mar 15, 2018
Last updated
Mar 17, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11418201-4405 UT
Family Nurse Practitioner 363LF0000X 351602 NY Primary

Addresses

Primary practice location

30 Broad St FL 45
New York, NY 10004-2942

Mailing address

149 W 200 N Apt 33
Salt Lake City, UT 84103-4530
Phone (970) 644-7703

Other practice location 1

8444 Summerlin Dr
Longmont, CO 80503-3906
Phone (303) 619-9252

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231117001449 NY Order and Referring Only - Nurse Practitioner 0749545986

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
351602NYMDFamily Nurse Practitioner
11418201-4405UTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Amaze Professional Medical Services PC CurrentSince May 1, 2023 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742169600000",
    "number": "1659874709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 W 200 N APT 33",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841034530",
            "telephone_number": "970-644-7703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 BROAD ST FL 45",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100042942",
            "telephone_number": "888-663-6331",
            "fax_number": "415-252-7176"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8444 Summerlin Dr",
            "address_purpose": "LOCATION",
            "city": "Longmont",
            "state": "CO",
            "postal_code": "805033906",
            "country_code": "US",
            "telephone_number": "303-619-9252",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AZBELL",
        "first_name": "ERIC",
        "middle_name": "ALLEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-15",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "11418201-4405",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "351602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.